NPIMap

Individual provider Active NPI

Samer Koleilat, RPH

  • Pharmacist
  • Fort Lauderdale, FL
National Provider Identifier
1962770099
Registry record updated Dec 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
PS30004 Issued in FL
Practice address
3101 N Ocean Blvd
Fort Lauderdale, FL 33308-7115
Phone
(954) 564-8424
NPI assigned
Dec 4, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X PS30004 FL Primary

Addresses

Primary practice location

3101 N Ocean Blvd
Fort Lauderdale, FL 33308-7115

Mailing address

2500 E Las Olas Blvd
Apt 1009
Fort Lauderdale, FL 33301-1508
Phone (954) 463-0613

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
PS30004FLMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Walgreen Co Past Accepting new patients
Walgreen Co Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1322956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322956800000",
    "number": "1962770099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 E LAS OLAS BLVD",
            "address_2": "APT 1009",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333011508",
            "telephone_number": "954-463-0613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3101 N OCEAN BLVD",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333087115",
            "telephone_number": "954-564-8424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLEILAT",
        "first_name": "SAMER",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-12-04",
        "last_updated": "2011-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS30004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.